不同时相缺血预处理对游离皮瓣缺血再灌注损伤的影响  

Effects of Ischemic Preconditioning at Different Time Points on Ischemia-Reperfusion Injury in Free Flaps

作　　者：王建新 凤旭东 孔二亮 王秀环 WANG Jianxin;FENG Xudong;KONG Erliang;WANG Xiuhuan(Department of Anesthesiology,988th Hospital of Joint Logistics Support Force of PLA,Zhengzhou Henan 450042,China)

机构地区：[1]中国人民解放军联勤保障部队第九八八医院麻醉科,河南郑州450042

出　　处：《临床研究》2024年第8期68-72,共5页Clinical Research

基　　金：河南省医学科技攻关项目(LHGJ20220921)。

摘　　要：目的观察不同时相缺血预处理(IPC)对游离皮瓣缺血再灌注损伤的影响。方法选取2022年12月至2023年7月中国人民解放军联勤保障部队第九八八医院收治的90例肢体损伤患者,全身麻醉下行择期股前外侧游离皮瓣移植术,采用随机数字表法分为A组(术前1 h IPC),B组(术前24 h IPC),C组(术前不进行IPC),每组30例。IPC采用3次短暂循环缺血/再灌注;在术前24 h(T_(0))、手术开始(T_(1))、术后1 h(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))分别取静脉血检测氧化应激指标[丙二醛(MDA)、诱导型一氧化氮合酶(iNOS)]、炎症因子指标[肿瘤坏死因子α(TNF-α)和P-选择素]水平,并统计术后7 d内皮瓣血管危象发生率和失活率。结果三组术后7 d血管危象发生率和皮瓣失活率比较,差异无统计学意义(P>0.05)。三组患者MDA、iNOS、TNF-α、P-选择素水平相比,差异有统计学意义(P<0.05);不同时间点的4个生化指标相比,差异具有统计学意义(P<0.05);不同组别与不同时间之间具有交互作用,差异具有统计学意义(P<0.05)。组内比较:与本组T_(0)比较,各组T_(2)~T_(4)的4个生化指标均升高,差异有统计学意义(P<0.05);与本组T_(2)比较,各组T_(3)~T_(4)时4个生化指标均降低,差异有统计学意义(P<0.05)。组间比较:T_(2)和T_(3)两个时间点,A组、B组分别与C组4个生化指标比较,差异有统计学意义(P<0.05),T_(2)、T_(3)时,A组与B组的4个生化指标比较,差异有统计学意义(P<0.05)。结论不同时相缺血预处理均能抑制氧化应激和炎症因子指标表达,对游离皮瓣有保护作用。Objective To observe the effects of ischemic preconditioning(IPC)at different time points on ischemia-reperfusion injury in free flaps.Methods Ninety patients with limb injuries treated at the 988th Hospital of Joint Logistics Support Force of PLA from December 2022 to July 2023 were selected.Under general anesthesia,elective anterolateral thigh free flap transplantation was performed.Patients were randomly divided into three groups using a random number table:Group A(IPC 1 hour before surgery),Group B(IPC 24 hours before surgery),and Group C(no IPC before surgery),with 30 cases in each group.IPC involved three cycles of brief ischemia/reperfusion.Venous blood samples were collected at 24 hours before surgery(T_(0)),at the start of surgery(T_(1)),1 hour after surgery(T_(2)),12 hours after surgery(T_(3)),and 24 hours after surgery(T_(4))to measure oxidative stress indicators[malondialdehyde(MDA),inducible nitric oxide synthase(iNOS)]and inflammatory factors[tumor necrosis factor-α(TNF-α)and P-selectin].The incidence and inactivation rates of vascular crises in the flaps within 7 days after surgery were recorded.Results There were no statistically significant differences in the incidence and inactivation rates of vascular crises in the flaps among the three groups within 7 days after surgery(P>0.05).The levels of MDA,iNOS,TNF-α,and P-selectin were significantly different among the three groups(P<0.05).The four biochemical indicators at different time points were significantly different(P<0.05).There was a significant interaction between different groups and different time points(P<0.05).Within-group comparisons:Compared with T_(0),the levels of the four biochemical indicators in each group increased at T_(2)~T_(4),with statistically significant differences(P<0.05).Compared with T_(2),the levels of the four biochemical indicators in each group decreased at T_(3)~T_(4),with statistically significant differences(P<0.05).Between-group comparisons:At T_(2) and T_(3),the levels of the four biochemical indicators in Gr

关 键 词：不同时相 缺血预处理 缺血再灌注损伤 游离皮瓣 

分 类 号：R614[医药卫生—麻醉学]